Neonatal resuscitation and birth asphyxia

Neonatal resuscitation

1. Neonatal resuscitation Dr.Raksha S K

2. Competencies covered Diagnosis of Birth asphyxia Principles of resuscitation

3. 1. Primi , 32years with 37weeks gestation presents to labour room with bleeding PV. She was shifted for emergency LSCS and delivered a male baby. Baby is not breathing at birth. After initial resuscitation baby was intubated and shifted to NICU and connected to mechanical ventilator. 2. G2P1L1 with 38 weeks GA, elective LSCS done under GA in view of breech, baby required prolonged ventilation, hence intubated and shifted to NICU 3. Primi , GDM, 4kg baby, difficult delivery, required forceps application, hypotonic at birth, required intubation and chest compression.

4. Birth asphyxia/Perinatal asphyxia Perinatal asphyxia is an insult to the fetus or newborn due to lack of oxygen (hypoxia) and/or a lack of perfusion (ischemia) to various organs.

5. Essential criteria for perinatal asphyxia

6. APGAR score

7. Perinatal depression- Condition of the infant in the immediate postnatal period i.e , in the first hour after birth-Depressed mental status, muscle hypotonia, disturbances in spontaneous respiration and cardiovascular function

8. NEONATAL ENCEPHALOPATHY : Abnormal neurobehavioral state with altered level of consciousness and signs of brainstem and/or motor dysfunction. HYPOXIC-ISCHEMIC ENCEPHALOPATHY (HIE) : Encephalopathy with hypoxic ischemic mechanism as the underlying cause HYPOXIC-ISCHEMIC BRAIN INJURY : Hypoxia and ischaemia detected by biochemical, electrophysiological, neuroimaging abnormalities

9. INCIDENCE Approximately 1-1.5 % of live births It occurs in 0.5 % of newborns > 36 weeks gestation and accounts for 20 % of perinatal deaths HIE: 6 : 1000 live term births Inversely related to gestational age and birth weight Higher incidence: Newborns of diabetic or severe PIH mothers, intrauterine growth restriction, breech presentation and post maturity Manual of Neonatal care – Cloherty 8 th edition

10. Factors that increase the risk of perinatal asphyxia : Impairment of maternal oxygenation Decreased blood flow from mother to placenta Decreased blood flow from placenta to fetus Impaired gas exchange across the placenta or at the fetal tissue level Increased fetal oxygen requirement

11. ETIOLOGY MATERNAL FACTORS Hypertension Hypotension Infection Hypoxia from pulmonary/cardiac disorders Diabetes Maternal vascular disease Uterine rupture Umbilical cord prolapse, true knot, compression FETAL FACTORS Anemia Infection Cardiomyopathy Hydrops Severe cardiac/circulatory insufficiency NEONATAL FACTORS Cyanotic congenital heart disease PPHN of the newborn Cardiomyopathy RDS Shock

12. Principles of resuscitation

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